Hormone Therapy for Prostate Cancer
Prostate cancer cells use the male hormone testosterone to grow. Hormone therapy lowers testosterone levels to “choke” the cancer’s ability to grow. Hormone therapy is also called androgen deprivation therapy (ADT). With less testosterone, prostate cancer tumors can shrink or stop growing. Symptoms can be eased, and the cancer may be slowed down, but hormone therapy cannot cure the cancer.
Causing your body to make less testosterone is either done with surgery or medication.
• Surgery: Removes the testicles and glands that make testosterone. The surgery is called an orchiectomy.
• Medication: Many types can lower how much testosterone the body makes. These drugs work slightly differently to slow testosterone production.
One type of drug is injected into the muscle or under the skin. This is called a luteinizing hormone-releasing hormone inhibitor (LH-RHs). The dose you get determines how long the effects will last (1-6 months).
A second type of hormone therapy is given with the first type or on its own. It’s called non-steroidal anti-androgens. These pills are given by mouth and they block cancer from finding testosterone.
• Intermittent vs. continuous hormone therapy: Most prostate cancers treated with hormone therapy stop responding over time. Some doctors believe in intermittent (on-again, off-again) treatment. Other doctors believe that continuous (ongoing) therapy might help men live longer. At this time, it isn’t clear which way is best. Men should think about how side effects weigh into their choices.
Who is a Good Candidate?
Hormone therapy is often used for:
• Men with advanced cancers
• Men with cancer that has come back after treatment
• Men who get radiation therapy. (It is used before and after radiation treatment to make cancer respond better to radiation.)
Men should talk about ADT with their urologist before deciding to use it.
Should I Consider Hormone Therapy?
Choosing the right treatment for prostate cancer is personal. It is best to make this choice with your doctor and the people closest to you. There are many things to think over before choosing ADT. Such as: your diagnosis, treatment goals, costs, and how well you can handle side effects. Before starting any type of hormone therapy, ask your health care provider questions, as well as questions about how to deal with side effects. Also talk about whether on-and-off or ongoing hormone therapy would be better for you.
What are the Benefits and Risks of Hormone Therapy?
The main benefit of hormone therapy for prostate cancer is that tumors can shrink or stop growing.
Side effects include:
• Hot flashes
• Anemia (low blood counts)
• Osteoporosis (loss of bone strength)
• Swollen and tender breasts
• Loss of sex drive and erectile dysfunction
• Genital shrinkage
These treatments have also been linked to heart disease and increased risk of heart attack. Hormone therapy may lead to diabetes. There are mixed thoughts about whether ADT can cause changes in memory. You should talk with your health care provider about all of these side effects before starting ADT.
Hormone therapy often works for a while — maybe it will work for a few years. Over time, the cancer will often “learn” how to bypass this treatment. Prostate cancer can then grow in spite of the low hormone level. When this happens, other treatments are needed to manage the cancer and its symptoms. If you have advanced cancer but, your cancer does not respond to ADT, you have choices. Many men move on to chemotherapy or other therapies, often with ADT to help. Talk to you doctor about which treatment is right for you.
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